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Rheumatology Advance Access originally published online on January 3, 2007
Rheumatology 2007 46(5):808-810; doi:10.1093/rheumatology/kel402
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Heart conduction disorders related to antimalarials toxicity: an analysis of electrocardiograms in 85 patients treated with hydroxychloroquine for connective tissue diseases

N. Costedoat-Chalumeau, J.-S. Hulot1, Z. Amoura, G. Leroux, P. Lechat1, C. Funck-Brentano2 and J.-C. Piette

AP-HP, Service de Médecine Interne du Professeur Piette, Centre de Référence National pour les Lupus et le Syndrome des Antiphospholipides, 1AP-HP, Service de Pharmacologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47-83 Boulevard de l’Hôpital, 75651 Paris Cedex 13 and 2INSERM, Clinical Investigation Center, CIC-9304; Pierre et Marie Curie University, Department of Pharmacology and AP-HP, Saint-Antoine University Hospital, Department of Pharmacology, Paris, F-75012, France.

Correspondence to: N. Costedoat-Chalumeau, AP-HP Service de Médecine Interne, Centre de Référence National pour les Lupus et le Syndrome des Antiphospholipides, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47-83 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France. E-mail: nathalie.costedoat{at}psl.aphp.fr


  Abstract

Objective. The antimalarial agents chloroquine (CQ) and hydroxychloroquine (HCQ) are used in long-term treatment of connective tissue diseases (CTDs). A high incidence of heart conduction disorders, including bundle-branch block and incomplete or complete atrioventricular block, has been observed among patients treated with CQ. Since no data were available for HCQ, we studied electrocardiograms (ECGs) in 85 unselected patients with CTD treated with HCQ as the sole antimalarial.

Methods. Eighty-five unselected out-patients treated with HCQ for a minimum of 1 yr, and without established cardiac diseases had standard 12-lead ECGs.

Results. Two incomplete right bundle-branch blocks and one left bundle-branch block were observed. No atrioventricular block was observed. The mean PR interval was 137 ± 20 ms (range 99–188). The mean QTc interval was 410 ms (range 349–464). The mean heart rate was 73 beats/min (range 53–102).

Conclusion. PR interval, QTc interval and heart rate were not different from normal values. The rate of heart conduction disorders was similar to what is expected in the general population, and contrasted with prior results in CQ-treated patients. Our results add further evidence on the safety of HCQ compared with CQ.

KEY WORDS: Hydroxychloroquine, Antimalarials, Atrioventricular block, Electrocardiogram, Toxicity, Heart conduction disorders

Submitted 17 May 2006; revised version accepted 31 October 2006.
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